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Takiguchi C, Inoue T. Effectiveness of a self-assessment application in evaluating the care coordination competency of intensive care unit nurses in managing patients on life support: An intervention study. Jpn J Nurs Sci 2024; 21:e12584. [PMID: 38273738 DOI: 10.1111/jjns.12584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 11/09/2023] [Accepted: 12/17/2023] [Indexed: 01/27/2024]
Abstract
AIM To examine the effectiveness of the feedback from the Nurses' Care Coordination Competency Scale (NCCCS) application (app) used for self-assessing the care coordination competency of intensive care unit (ICU) nurses in managing patients on life support. METHODS A non-randomized open-label study was conducted in Japan from November 2021 to March 2022. Participants were 318 ICU nurses from acute hospitals in Japan. They were divided manually into two groups based on their certification status. The intervention was immediate feedback on the results of the care coordination competency self-assessment through the NCCCS app; the control group performed the NCCCS survey with no feedback. The primary outcome was an increase in the NCCCS score 1 month after the intervention. Mann-Whitney U test was used to compare the scores of the intervention and control groups. Wilcoxon's signed rank sum test was used to compare the scores in the first and second NCCCS surveys. RESULTS Forty-one participants were lost to follow-up, leaving 277 participants (intervention = 141, control = 136) for analysis. One month later, NCCCS scores similarly increased in both groups. For nurses with at least 5 years of ICU experience (n = 152), the NCCCS score increased in the intervention group (n = 75) (rising point mean: 4.8, standard deviation [SD]: 9.8) compared with that in the control group (n = 77) (rising point mean: 1.3, SD: 8.3) (p = .048). CONCLUSIONS Feedback from the NCCCS app can improve care coordination behavior. However, a certain level of ICU experience may be required to translate feedback into improved behavior.
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Affiliation(s)
| | - Tomoko Inoue
- International University of Health and Welfare, Tokyo, Japan
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2
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Trisyani Y, Emaliyawati E, Prawesti A, Mirwanti R, Mediani HS. Emergency Nurses' Competency in the Emergency Department Context: A Qualitative Study. Open Access Emerg Med 2023; 15:165-175. [PMID: 37197564 PMCID: PMC10183472 DOI: 10.2147/oaem.s405923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 04/18/2023] [Indexed: 05/19/2023] Open
Abstract
Background The availability of clear emergency nurses' competencies is critical for safe and effective emergency health care services. The study regarding emergency nurses' competencies remained virtually limited. Purpose This study aimed to explore the emergency nurses' competencies in the clinical emergency department (ED) context as needed by society. Methods This qualitative study involved focus group discussions in six groups of 54 participants from three EDs. The data were analysed using grounded theory approach including the constant comparative, interpretations, and coding procedures; initial coding, focused coding and categories. Results This study revealed 8 core competencies of emergency nurses: Shifting the nursing practice, Caring for acute critical patients, Communicating and coordinating, Covering disaster nursing roles, Reflecting on the ethical and legal standards, Researching competency, Teaching competencies and Leadership competencies. The interconnection of the 8 core competencies has resulted in 2 concepts of extending the ED nursing practice and demanding the advanced ED nursing role. Conclusion The finding reflected the community needs of nurses who work in ED settings and the need for competency development of emergency nurses.
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Affiliation(s)
- Yanny Trisyani
- Department of Critical Care Nursing and Emergency Nursing Faculty of Nursing, Universitas Padjadjaran, Bandung, West Java, Indonesia
- Correspondence: Yanny Trisyani, Email ;
| | - Etika Emaliyawati
- Department of Critical Care Nursing and Emergency Nursing Faculty of Nursing, Universitas Padjadjaran, Bandung, West Java, Indonesia
| | - Ayu Prawesti
- Department of Critical Care Nursing and Emergency Nursing Faculty of Nursing, Universitas Padjadjaran, Bandung, West Java, Indonesia
| | - Ristina Mirwanti
- Department of Critical Care Nursing and Emergency Nursing Faculty of Nursing, Universitas Padjadjaran, Bandung, West Java, Indonesia
| | - Henny Suzana Mediani
- Department of Pediatric Nursing, Faculty of Nursing, Universitas Padjadjaran, Bandung, West Java, Indonesia
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3
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Wise S, Duffield C, Fry M, Roche M. Nurses' role in accomplishing interprofessional coordination: Lessons in 'almost managing' an emergency department team. J Nurs Manag 2021; 30:198-204. [PMID: 34436800 DOI: 10.1111/jonm.13464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 08/17/2021] [Accepted: 08/23/2021] [Indexed: 12/01/2022]
Abstract
AIM To describe how nurse coordinators accomplished day-to-day interprofessional coordination in an Australian emergency department team, drawing some lessons for the design of nurse coordinator roles in other settings. BACKGROUND Previous studies have examined leadership within nursing teams, and there are a growing number of registered nurses employed as care coordinators. There is limited literature on how the day-to-day coordination of interprofessional teams is accomplished, and by whom. METHOD Nineteen semi-structured interviews with emergency department registered nurses, doctors and nurse practitioners analysed thematically. RESULTS Three themes describe how coordinators accomplished interprofessional coordination: task coordination and oversight, taking action to maintain patient flow and negotiating an ambiguous role. CONCLUSION Better-defined nurse coordinator roles with clearer authority and associated training are essential for consistent practice. However, accomplishing interprofessional coordination will always require the situated knowledge of the complex nursing-medical division of labour in the workplace and the interpersonal relationships that are only gained through experience. IMPLICATIONS FOR NURSING MANAGEMENT The design of nurse coordinator roles must include the thorny question of 'who leads' interprofessional teams in the day-to-day coordination of tasks. New and inexperienced nurses may not have the necessary situated knowledge or interpersonal relationships to succeed. However, such roles offer an important development opportunity for future nurse managers.
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Affiliation(s)
- Sarah Wise
- Centre for Health Economics Research and Evaluation, Faculty of Business, University of Technology Sydney, Sydney, NSW, Australia
| | - Christine Duffield
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia.,Nursing and Health Services Management, School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA, Australia
| | - Margaret Fry
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia.,Northern Sydney Local Health District, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Michael Roche
- School of Nursing, Midwifery, and Public Health, University of Canberra, Canberra, ACT, Australia
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4
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Kunrath GM, Santarem MD, Oliveira JLCD, Machado MLP, Camargo MPD, Rosa NGD, Almeida VMD, Vieira LB. Predictors associated with absenteeism-disease among Nursing professionals working in an emergency hospital service. Rev Gaucha Enferm 2021; 42:e20190433. [PMID: 33566942 DOI: 10.1590/1983-1447.2021.20190433] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 06/19/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To verify the predictors associated with sick leave from 15 days onwards among Nursing professionals of an emergency hospital service. METHOD A cross-sectional, retrospective, and descriptive-analytical study. The sample consists of the records of sick leave (n=2,403) due to diseases of the Nursing professionals (n=197) working in an emergency hospital service in southern Brazil, from 2013 to 2018. Descriptive and statistical analysis was used, as well as the multivariate regression model. RESULTS There was predominance of females (72.6%), white-skinned (86.3%), with a mean age of 45.05 (SD=9.77) years old, and nursing technicians (74.6%). The prevalent cause of sick leave was related to clinical diseases (62.5%). The predictors associated with sick leave from 15 days onwards were the following: Age (OR: 0.97; 95% CI=0.95-0.99) and Musculoskeletal Diseases (OR: 8.95; 95% CI=5.30-15.11). CONCLUSION Age and musculoskeletal diseases were predictors of sick leave from 15 days onwards of the Nursing team.
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Affiliation(s)
- Gustavo Mattes Kunrath
- Hospital de Clínicas de Porto Alegre (HCPA), Serviço de Enfermagem em Emergência. Porto Alegre, Rio Grande do Sul, Brasil
| | - Michelle Dornelles Santarem
- Universidade Federal do Rio Grande do Sul (UFRGS), Escola de Enfermagem, Departamento de Enfermagem Médico-Cirúrgica. Porto Alegre, Rio Grande do Sul, Brasil
| | - João Lucas Campos de Oliveira
- Universidade Federal do Rio Grande do Sul (UFRGS), Escola de Enfermagem, Departamento de Assistência e Orientação Profissional. Porto Alegre, Rio Grande do Sul, Brasil
| | - Maria Luiza Paz Machado
- Universidade Federal do Rio Grande do Sul (UFRGS), Escola de Enfermagem, Departamento de Enfermagem Médico-Cirúrgica. Porto Alegre, Rio Grande do Sul, Brasil
| | - Morgana Pescador de Camargo
- Hospital de Clínicas de Porto Alegre (HCPA), Serviço de Enfermagem em Emergência. Porto Alegre, Rio Grande do Sul, Brasil
| | - Ninon Girardon da Rosa
- Universidade Federal do Rio Grande do Sul (UFRGS), Escola de Enfermagem, Departamento de Assistência e Orientação Profissional. Porto Alegre, Rio Grande do Sul, Brasil
| | - Valmir Machado de Almeida
- Hospital de Clínicas de Porto Alegre (HCPA), Serviço de Enfermagem em Emergência. Porto Alegre, Rio Grande do Sul, Brasil
| | - Letícia Becker Vieira
- Universidade Federal do Rio Grande do Sul (UFRGS), Escola de Enfermagem, Departamento de Assistência e Orientação Profissional. Porto Alegre, Rio Grande do Sul, Brasil
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Sy A, Moglia B, Aragunde G, Derossi P. Emergency care under the magnifying glass: a review of ethnographic studies in the scientific literature on hospital emergency services. CAD SAUDE PUBLICA 2021; 37:e00026120. [PMID: 33503159 DOI: 10.1590/0102-311x00026120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 09/23/2020] [Indexed: 12/20/2022] Open
Abstract
The article presents a review of ethnographic studies in the scientific literature on hospital emergency services, with the objective of systematizing the studies and their principal findings, referring to the health-disease-healthcare process in hospital emergency services from an ethnographic perspective. An integrative literature review was performed of studies published in Argentine and international indexed journals and in the following electronic databases: PubMed, VHL, Scopus, Redalyc, and SciELO. The corpus of the analysis consisted of a total of 69 articles, which were submitted to content analysis, having identified the following analytical dimensions: quality of care, communication and bonds, subjectivity, application of information technologies, methodological reflection, patients' experiences and practices, decision-making, and violence. The results allowed identifying a process that differs from guidelines and protocols, in which healthcare workers' subjective aspects, communication and interpersonal relations, and working conditions shape, orient, and condition the treatment and care provided in the hospital. The article thus highlights the approach to subjective aspects in health studies, to understand not only health workers' perspectives and experiences but also the persistent barriers to providing better quality of care, complexifying a problem ignored by a large share of the analyses.
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Affiliation(s)
- Anahi Sy
- Instituto de Salud Colectiva, Universidad Nacional de Lanús, Buenos Aires, Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
| | - Brenda Moglia
- Instituto de Salud Colectiva, Universidad Nacional de Lanús, Buenos Aires, Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
| | - Gisele Aragunde
- Instituto de Salud Colectiva, Universidad Nacional de Lanús, Buenos Aires, Argentina
| | - Paula Derossi
- Instituto de Salud Colectiva, Universidad Nacional de Lanús, Buenos Aires, Argentina
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Broadbent M, Moxham L, Dwyer T. Understanding nurses perspectives of acuity in the process of emergency mental health triage: a qualitative study. Contemp Nurse 2020; 56:280-295. [PMID: 33086935 DOI: 10.1080/10376178.2020.1841014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Background: Post deinstitutionalisation, mental health mainstreaming has led to substantial increases in presentations to Emergency Departments (EDs). The assessment process requires the ED triage nurse to undertake a rapid client assessment, assign a clinically appropriate triage score, and then refer the client to a mental health clinician. The initial assessment is important, and a number of factors influence the process of triage, referral and response including an understanding of mental health presentation acuity. Aim: To understand the factors that influence the ED triage assessment, referral and clinical response of clients with a mental illness. Methods: An ethnographic methodology underpinned the research design. ED triage nurses and mental health triage nurses who worked in a regional hospital provided insights through interviews and observations. The study was also informed by institutional policies and procedures regarding triage. Transcribed in-depth interviews, field notes and memos were analysed using an inductive thematic process. Findings: Mental health triage nurses and ED triage nurses concur that triage is an important part of the assessing process for a person who presents to the ED with a mental health problem. Timely and clinically accurate assessment, followed by referral and response is strongly influenced by the user knowledge of the mental health triage scale, and comprehension of mental health acuity. The conflicting understandings between the two professional nursing groups, called professionally cultured orientations, further impact this process. Conclusion: Professionally cultured orientation to mental health triage and acuity comprehension influence the process of emergency mental health triage and therefore may affect optimal client outcomes. Further research into ED triage design, ED triage education, and a shared understanding of acuity is called for.
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Affiliation(s)
- Marc Broadbent
- School of Nursing, Midwifery & Paramedicine, University of the Sunshine Coast, ML 40 Locked Bag 4, Maroochydore DC, QLD 4558, Australia
| | - Lorna Moxham
- School of Nursing, University of Wollongong, Northfields Ave, Wollongong, NSW 2522, Australia
| | - Trudy Dwyer
- School of Nursing, Midwifery & Social Sciences, Central Queensland University, Building 18 Bruce Hwy, Rockhampton, QLD, 4702, Australia
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Gagnon J, Rahimzadeh V, Longo C, Nugus P, Bartlett G. Understanding how professionals cultures impact implementation of a pediatric oncology genomic test. J Health Organ Manag 2019. [DOI: 10.1108/jhom-10-2018-0297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Healthcare innovation, exemplified by genomic medicine, requires increasingly sophisticated understanding of the interdisciplinary-organizational context in which new innovations are implemented. Deliberative stakeholder consultations are public engagement tools that are gaining increasing traction in health care, as a means of maximizing the diversity of roles and interests vested in a particular policy or practice issue. They engage participants from different knowledge systems (“cultures”) in mutually respectful debate to enable group consensus on implementation strategies. Current deliberation analytic methods tend to overlook the cultural contexts of the deliberative process. The paper aims to discuss this issue.
Design/methodology/approach
This conceptual paper proposes adding ethnographic participant observation to provide a more comprehensive account of the process that gives rise to deliberative outputs. To underpin this conceptual paper, the authors draw on the authors’ experience engaging healthcare professionals during implementation of genomics in the care for pediatric oncology patients with treatment-resistant glioblastoma at two tertiary care hospitals.
Findings
Ethnography enabled a deeper understanding of deliberative outcomes by combining rhetorical and non-rhetorical analysis to identify the implementation and coordination of care barriers across professional cultures.
Originality/value
This paper highlights the value of ethnographic methods in enabling a more comprehensive assessment of the quality of engagement across professional cultures in implementation studies.
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8
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Trisyani Y, Windsor C. Expanding knowledge and roles for authority and practice boundaries of Emergency Department nurses: a grounded theory study. Int J Qual Stud Health Well-being 2019; 14:1563429. [PMID: 30764727 PMCID: PMC6384512 DOI: 10.1080/17482631.2018.1563429] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Purpose: While emergency department nurses in Indonesia are critical to quality care, the role lacks recognition and standard practices and regulation of scope of practice are absent. This research explored the role of nurses in Indonesian EDs. Method: The conceptual lens applied in the research was grounded theory. The main data source was 51 semi- structured interviews with 43 ED nurses, three directors of nursing, three nurse leaders and two nurse educators. Data were also generated through observations and memos. Results: Two key categories were constructed; shifting work boundaries and lack of authority. Shifting work boundaries was symbolic of a lack of professional authority and legitimized knowledge. Lack of authority reflected the dimension of professional autonomy through the nexus of power and knowledge. The interrelationship of these two concepts constructed a core category, securing legitimate power, which underpinned the positioning of nursing in Indonesia. Conclusions: The interconnection between political gains, tertiary knowledge, professional regulation and implementation of gender-sensitive policies was critical to the development of the ED role, the positioning of nursing within the health care system and improvement in quality of care.
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Affiliation(s)
- Yanny Trisyani
- a Emergency Nursing and Critical Care Nursing Department , Universitas Padjadjaran , Bandung , Indonesia
| | - Carol Windsor
- b Postgraduate Research Coordinator , Queensland University of Technology , Brisbane , Australia
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Schot E, Tummers L, Noordegraaf M. Working on working together. A systematic review on how healthcare professionals contribute to interprofessional collaboration. J Interprof Care 2019; 34:332-342. [DOI: 10.1080/13561820.2019.1636007] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Evert Schot
- School of Governance, Utrecht University, Utrecht, Netherlands
| | - Lars Tummers
- School of Governance, Utrecht University, Utrecht, Netherlands
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10
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Purdy E, Alexander C, Caughley M, Bassett S, Brazil V. Identifying and Transmitting the Culture of Emergency Medicine Through Simulation. AEM EDUCATION AND TRAINING 2019; 3:118-128. [PMID: 31008423 PMCID: PMC6457353 DOI: 10.1002/aet2.10325] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 01/11/2019] [Accepted: 01/14/2019] [Indexed: 06/01/2023]
Abstract
BACKGROUND Simulation is commonly used in medical education. It offers the opportunity for participants to apply theoretical knowledge and practice nontechnical skills. We aimed to examine how simulation may also help to identify emergency medicine culture and serve as a tool to transmit values, beliefs, and practices to medical learners. METHODS We undertook a focused ethnography of a simulated emergency department exercise delivered to 98 third-year medical students. This ethnography included participant observation, informal interviews, and document review. Analysis was performed using a recursive method, a simultaneous deductive and inductive approach to data interpretation. RESULTS All 20 staff (100%) and 92 of 98 medical students (94%) participated in the study. We identified seven core values-identifying and treating dangerous pathology, managing uncertainty, patients and families at the center of care, balancing needs and resources at the system level, value of the team approach, education as integral, and emergency medicine as part of self-identity-and 27 related beliefs that characterized emergency medicine culture. We observed that culture was transmitted during the simulation exercise. CONCLUSION This study contributes to the characterization of the culture of emergency medicine by identifying core values and beliefs that are foundational to the specialty. Simulation facilitated cultural compression, which allowed for ready identification of values, beliefs, and practices and also facilitated transmission of culture to learners. This study expands understanding of the culture of emergency medicine and the role of simulation in the process of cultural exchange.
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Affiliation(s)
- Eve Purdy
- Queen's UniversityKingstonOntarioCanada
- Gold Coast University HospitalSouthportQueenslandAustralia
| | | | | | | | - Victoria Brazil
- Gold Coast University HospitalSouthportQueenslandAustralia
- Bond UniversityRobina QueenslandAustralia
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11
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Forero R, Nahidi S, de Costa J, Fatovich D, FitzGerald G, Toloo S, McCarthy S, Mountain D, Gibson N, Mohsin M, Man WN. Perceptions and experiences of emergency department staff during the implementation of the four-hour rule/national emergency access target policy in Australia: a qualitative social dynamic perspective. BMC Health Serv Res 2019; 19:82. [PMID: 30700302 PMCID: PMC6354365 DOI: 10.1186/s12913-019-3877-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 01/04/2019] [Indexed: 11/25/2022] Open
Abstract
Background The Four-Hour Rule or National Emergency Access Target policy (4HR/NEAT) was implemented by Australian State and Federal Governments between 2009 and 2014 to address increased demand, overcrowding and access block (boarding) in Emergency Departments (EDs). This qualitative study aimed to assess the impact of 4HR/NEAT on ED staff attitudes and perceptions. This article is part of a series of manuscripts reporting the results of this project. Methods The methodology has been published in this journal. As discussed in the methods paper, we interviewed 119 participants from 16 EDs across New South Wales (NSW), Queensland (QLD), Western Australia (WA) and the Australian Capital Territory (ACT), in 2015–2016. Interviews were recorded, transcribed, imported to NVivo 11 and analysed using content and thematic analysis. Results Three key themes emerged: Stress and morale, Intergroup dynamics, and Interaction with patients. These provided insight into the psycho-social dimensions and organisational structure of EDs at the individual, peer-to-peer, inter-departmental, and staff-patient levels. Conclusion Findings provide information on the social interactions associated with the introduction of the 4HR/NEAT policy and the intended and unintended consequences of its implementation across Australia. These themes allowed us to develop several hypotheses about the driving forces behind the social impact of this policy on ED staff and will allow for development of interventions that are rooted in the rich context of the staff’s experiences.
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Affiliation(s)
- Roberto Forero
- Simpson Centre for Health Services Research, South Western Sydney Clinical School, University of NSW, Liverpool BC, NSW, 1871, Australia. .,Ingham Institute for Applied Medical Research, Liverpool Hospital, Liverpool, NSW, Australia.
| | - Shizar Nahidi
- Simpson Centre for Health Services Research, South Western Sydney Clinical School, University of NSW, Liverpool BC, NSW, 1871, Australia.,Ingham Institute for Applied Medical Research, Liverpool Hospital, Liverpool, NSW, Australia
| | - Josephine de Costa
- Simpson Centre for Health Services Research, South Western Sydney Clinical School, University of NSW, Liverpool BC, NSW, 1871, Australia.,Ingham Institute for Applied Medical Research, Liverpool Hospital, Liverpool, NSW, Australia
| | - Daniel Fatovich
- Department of Emergency Medicine, Royal Perth Hospital, Perth, WA, Australia.,Discipline of Emergency Medicine, University of Western Australia, Crawley, WA, Australia
| | - Gerry FitzGerald
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
| | - Sam Toloo
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
| | - Sally McCarthy
- Emergency Department, Prince of Wales Hospital , Randwick, NSW, Australia.,Prince of Wales Clinical School, University of NSW, Kensington, NSW, Australia
| | - David Mountain
- Department of Emergency Medicine, Sir Charles Gairdner Hospital, Crawley, WA, Australia.,Discipline of Emergency Medicine, University of Western Australia, Crawley, WA, Australia
| | - Nick Gibson
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA, Australia
| | - Mohammed Mohsin
- Psychiatry Research and Teaching UNit, Liverpool Hospital, NSW Health, Liverpool, NSW, Australia.,School of Psychiatry, Faculty of Medicine, University of NSW, Sydney, NSW, Australia
| | - Wing Nicola Man
- Simpson Centre for Health Services Research, South Western Sydney Clinical School, University of NSW, Liverpool BC, NSW, 1871, Australia.,Ingham Institute for Applied Medical Research, Liverpool Hospital, Liverpool, NSW, Australia
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12
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Forero R, Nahidi S, De Costa J, Mohsin M, Fitzgerald G, Gibson N, McCarthy S, Aboagye-Sarfo P. Application of four-dimension criteria to assess rigour of qualitative research in emergency medicine. BMC Health Serv Res 2018; 18:120. [PMID: 29454350 PMCID: PMC5816375 DOI: 10.1186/s12913-018-2915-2] [Citation(s) in RCA: 205] [Impact Index Per Article: 34.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 02/06/2018] [Indexed: 11/25/2022] Open
Abstract
Background The main objective of this methodological manuscript was to illustrate the role of using qualitative research in emergency settings. We outline rigorous criteria applied to a qualitative study assessing perceptions and experiences of staff working in Australian emergency departments. Methods We used an integrated mixed-methodology framework to identify different perspectives and experiences of emergency department staff during the implementation of a time target government policy. The qualitative study comprised interviews from 119 participants across 16 hospitals. The interviews were conducted in 2015–2016 and the data were managed using NVivo version 11. We conducted the analysis in three stages, namely: conceptual framework, comparison and contrast and hypothesis development. We concluded with the implementation of the four-dimension criteria (credibility, dependability, confirmability and transferability) to assess the robustness of the study, Results We adapted four-dimension criteria to assess the rigour of a large-scale qualitative research in the emergency department context. The criteria comprised strategies such as building the research team; preparing data collection guidelines; defining and obtaining adequate participation; reaching data saturation and ensuring high levels of consistency and inter-coder agreement. Conclusion Based on the findings, the proposed framework satisfied the four-dimension criteria and generated potential qualitative research applications to emergency medicine research. We have added a methodological contribution to the ongoing debate about rigour in qualitative research which we hope will guide future studies in this topic in emergency care research. It also provided recommendations for conducting future mixed-methods studies. Future papers on this series will use the results from qualitative data and the empirical findings from longitudinal data linkage to further identify factors associated with ED performance; they will be reported separately. Electronic supplementary material The online version of this article (10.1186/s12913-018-2915-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Roberto Forero
- The Simpson Centre for Health Services Research, South Western Sydney Clinical School and the Ingham Institute for Applied Research, Liverpool Hospital, UNSW, Liverpool, NSW, 1871, Australia.
| | - Shizar Nahidi
- The Simpson Centre for Health Services Research, South Western Sydney Clinical School and the Ingham Institute for Applied Research, Liverpool Hospital, UNSW, Liverpool, NSW, 1871, Australia
| | - Josephine De Costa
- The Simpson Centre for Health Services Research, South Western Sydney Clinical School and the Ingham Institute for Applied Research, Liverpool Hospital, UNSW, Liverpool, NSW, 1871, Australia
| | - Mohammed Mohsin
- Psychiatry Research and Teaching Unit, Liverpool Hospital, NSW Health, Sydney, Australia.,School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Gerry Fitzgerald
- School - Public Health and Social Work, Queensland University of Technology (QUT), Brisbane, Qld, Australia.,Australasian College for Emergency Medicine (ACEM), Melbourne, VIC, Australia
| | - Nick Gibson
- School of Nursing and Midwifery, Edith Cowan University (ECU), Perth, WA, Australia
| | - Sally McCarthy
- Australasian College for Emergency Medicine (ACEM), Melbourne, VIC, Australia.,Emergency Care Institute (ECI), NSW Agency for Clinical Innovation (ACI), Sydney, Australia
| | - Patrick Aboagye-Sarfo
- Clinical Support Directorate, System Policy & Planning Division, Department of Health WA, Perth, WA, Australia
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13
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Nelson P, Bell AJ, Nathanson L, Sanchez LD, Fisher J, Anderson PD. Ethnographic analysis on the use of the electronic medical record for clinical handoff. Intern Emerg Med 2017; 12:1265-1272. [PMID: 27832465 DOI: 10.1007/s11739-016-1567-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 10/24/2016] [Indexed: 02/07/2023]
Abstract
The objective of this study was to understand the social elements of clinical and organizational interactions of the key stakeholders in the specific context of an electronic dashboard used by the emergency department (ED) and inpatient medicine teams at the time of clinical referral and handover. An electronic handover function is utilised at the ED-inpatient interface at this institution and has given clinicians the ability to better communicate, monitor the department and strive to improve patient safety in streamline the delivery of care in the acute phase. This study uses an ethnographic qualitative research design incorporating semistructured interviews, participant observation on the ED floor and fieldwork notes. The setting for this research was in the ED at a tertiary University affiliated hospital. Triangulation was used to combine information obtained from multiple sources and information from fieldwork and interviews refined into useable chunks culminating in a thematic analysis. Thematic analysis yielded five central themes that reflected how the clinical staff utilised this IT system and why it had become embedded in the culture of clinical referral and handover. Efficient time management for improved patient flow was demonstrated, value added communication (at the interpersonal level), the building trust at the ED-inpatient interface, the maintenance of mutual respect across medical cultures and an overall enhancement of the quality of ED communication (in terms of the information available). A robust electronic handover process, resulted in an integrated approach to patient care by removing barriers to admission for medical inpatients, admitted via ED. The value proposition for patients was a more complete information transfer, both within the ED and between departments.
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Affiliation(s)
| | - Anthony J Bell
- RBWH Department of Emergency Medicine, Butterfield St, Herston, QLD, 4006, Australia.
| | - Larry Nathanson
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, USA
| | - Leon D Sanchez
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, USA
| | - Jonathan Fisher
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, USA
| | - Philip D Anderson
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, USA
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Silva SSD, Assis MMA, Santos AMD. ENFERMEIRA COMO PROTAGONISTA DO GERENCIAMENTO DO CUIDADO NA ESTRATÉGIA SAÚDE DA FAMÍLIA: DIFERENTES OLHARES ANALISADORES. TEXTO & CONTEXTO ENFERMAGEM 2017. [DOI: 10.1590/0104-07072017001090016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo: discutir como os sujeitos sociais (equipe de saúde, de enfermagem, dirigentes e usuários) visualizam as práticas de gerenciamento do cuidado da enfermeira na Estratégia Saúde da Família. Método: estudo qualitativo, com dados obtidos por meio da entrevista semiestruturada (102 pessoas) e observação da prática (11 unidades de saúde da família) e analisados através da análise temática de conteúdo e fluxograma analisador. Resultados: o estudo revelou que o gerenciamento do cuidado é marcado pelo protagonismo da enfermeira, que assume a resolução dos problemas e, para isso, desenvolve estratégias de cuidado baseadas em ações programáticas e educação em saúde. Tal realidade evidencia as múltiplas ações da enfermeira e sugere a abertura de possibilidades de ampliação da autonomia com corresponsabilidade. Conclusão: a prática de gerenciamento do cuidado envolve múltiplas ações, o que exige atuações compartilhadas entre a equipe de saúde e de enfermagem, a partir da escuta qualificada das necessidades dos usuários.
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Nugus P, McCarthy S, Holdgate A, Braithwaite J, Schoenmakers A, Wagner C. Packaging Patients and Handing Them Over: Communication Context and Persuasion in the Emergency Department. Ann Emerg Med 2017; 69:210-217.e2. [DOI: 10.1016/j.annemergmed.2016.08.456] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 08/11/2016] [Accepted: 08/24/2016] [Indexed: 11/15/2022]
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Kirk JW, Nilsen P. Implementing evidence-based practices in an emergency department: contradictions exposed when prioritising a flow culture. J Clin Nurs 2016; 25:555-65. [PMID: 26818380 PMCID: PMC4738684 DOI: 10.1111/jocn.13092] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2015] [Indexed: 11/29/2022]
Abstract
Background An emergency department is typically a place of high activity where practitioners care for unanticipated presentations, which yields a flow culture so that actions that secure available beds are prioritised by the practitioners. Objectives How does the flow culture in an emergency department influence nurses’ use of a research‐based clinical guideline and a nutrition screening routine. Methods Ethnographic fieldwork was carried out over three months. The first author followed nurses, medical secretaries and doctors in the emergency department. Data were also collected by means of semi‐structured interviews. An activity system analysis, as described in the Cultural Historical Activity Theory, was conducted to identify various contradictions that could exist between different parts of the activity system. Results The main contradiction identified was that guidelines and screening routines provided a flow stop. Four associated contradictions were identified: insufficient time to implement guidelines; guilty conscience due to perceived nonadherence to evidence‐based practices; newcomers having different priorities; and conflicting views of what constituted being a professional. Conclusion We found that research‐supported guidelines and screening routines were not used if they were perceived to stop the patient flow, suggesting that the practice was not fully evidence based.
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Affiliation(s)
- Jeanette W Kirk
- Optimed, Clinical Research Centre, Hvidovre, Denmark.,Department of Development and Quality, University Hospital Hvidovre, Hvidovre, Denmark.,Department of Education, Aarhus University, Emdrup, Denmark
| | - Per Nilsen
- Division of Community Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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Molina KL, Moura GMSSD. A satisfação dos pacientes segundo a forma de internação em hospital universitário. ACTA PAUL ENFERM 2016. [DOI: 10.1590/1982-0194201600004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo Objetivo Analisar a satisfação dos pacientes de acordo com a forma de internação em hospital universitário. Métodos Estudo transversal realizado com 366 pacientes com mais de 18 anos, internados em unidades clínicas e cirúrgicas no período de janeiro a junho de 2014, cujo desfecho tenha sido a alta entre 15 e 30 dias. Teste Mann-Whitney foi realizado para analisar amostras independentes para comparação entre os grupos. Resultados Estiveram satisfeitos e muito satisfeitos com o atendimento recebido 99,4% dos pacientes internados pela emergência e 98,4% dos internados pela admissão, apresentando médias de satisfação de 5,66 e 5,55, respectivamente. A média de satisfação foi mais elevada em todos os atributos para o grupo da emergência. A comparação entre grupos dos atributos da equipe de Enfermagem e satisfação geral não demonstrou significância estatística. Conclusão O elevado nível de satisfação dos pacientes com o serviço de saúde evidenciou a qualidade assistencial prestada no hospital universitário, na perspectiva do paciente. Destacou-se igual e elevada avaliação da satisfação com enfermagem entre os grupos.
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Pinkney J, Rance S, Benger J, Brant H, Joel-Edgar S, Swancutt D, Westlake D, Pearson M, Thomas D, Holme I, Endacott R, Anderson R, Allen M, Purdy S, Campbell J, Sheaff R, Byng R. How can frontline expertise and new models of care best contribute to safely reducing avoidable acute admissions? A mixed-methods study of four acute hospitals. HEALTH SERVICES AND DELIVERY RESEARCH 2016. [DOI: 10.3310/hsdr04030] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundHospital emergency admissions have risen annually, exacerbating pressures on emergency departments (EDs) and acute medical units. These pressures have an adverse impact on patient experience and potentially lead to suboptimal clinical decision-making. In response, a variety of innovations have been developed, but whether or not these reduce inappropriate admissions or improve patient and clinician experience is largely unknown.AimsTo investigate the interplay of service factors influencing decision-making about emergency admissions, and to understand how the medical assessment process is experienced by patients, carers and practitioners.MethodsThe project used a multiple case study design for a mixed-methods analysis of decision-making about admissions in four acute hospitals. The primary research comprised two parts: value stream mapping to measure time spent by practitioners on key activities in 108 patient pathways, including an embedded study of cost; and an ethnographic study incorporating data from 65 patients, 30 carers and 282 practitioners of different specialties and levels. Additional data were collected through a clinical panel, learning sets, stakeholder workshops, reading groups and review of site data and documentation. We used a realist synthesis approach to integrate findings from all sources.FindingsPatients’ experiences of emergency care were positive and they often did not raise concerns, whereas carers were more vocal. Staff’s focus on patient flow sometimes limited time for basic care, optimal communication and shared decision-making. Practitioners admitted or discharged few patients during the first hour, but decision-making increased rapidly towards the 4-hour target. Overall, patients’ journey times were similar, although waiting before being seen, for tests or after admission decisions, varied considerably. The meaning of what constituted an ‘admission’ varied across sites and sometimes within a site. Medical and social complexity, targets and ‘bed pressure’, patient safety and risk, each influenced admission/discharge decision-making. Each site responded to these pressures with different initiatives designed to expedite appropriate decision-making. New ways of using hospital ‘space’ were identified. Clinical decision units and observation wards allow potentially dischargeable patients with medical and/or social complexity to be ‘off the clock’, allowing time for tests, observation or safe discharge. New teams supported admission avoidance: an acute general practitioner service filtered patients prior to arrival; discharge teams linked with community services; specialist teams for the elderly facilitated outpatient treatment. Senior doctors had a range of roles: evaluating complex patients, advising and training juniors, and overseeing ED activity.ConclusionsThis research shows how hospitals under pressure manage complexity, safety and risk in emergency care by developing ‘ground-up’ initiatives that facilitate timely, appropriate and safe decision-making, and alternative care pathways for lower-risk, ambulatory patients. New teams and ‘off the clock’ spaces contribute to safely reducing avoidable admissions; frontline expertise brings value not only by placing senior experienced practitioners at the front door of EDs, but also by using seniors in advisory roles. Although the principal limitation of this research is its observational design, so that causation cannot be inferred, its strength is hypothesis generation. Further research should test whether or not the service and care innovations identified here can improve patient experience of acute care and safely reduce avoidable admissions.FundingThe National Institute for Health Research (NIHR) Health Services and Delivery Research programme (project number 10/1010/06). This research was supported by the NIHR Collaboration for Leadership in Applied Health Research and Care South West Peninsula.
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Affiliation(s)
- Jonathan Pinkney
- Centre for Clinical Trials and Population Studies, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | - Susanna Rance
- Centre for Clinical Trials and Population Studies, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
- Institute for Health and Human Development, University of East London, London, UK
| | - Jonathan Benger
- Department of Nursing and Midwifery, University of the West of England, Bristol, UK
| | - Heather Brant
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | | | - Dawn Swancutt
- Centre for Clinical Trials and Population Studies, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | - Debra Westlake
- Centre for Clinical Trials and Population Studies, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | | | - Daniel Thomas
- Centre for Clinical Trials and Population Studies, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | - Ingrid Holme
- Faculty of Social Sciences, University of Ulster, Londonderry, UK
| | - Ruth Endacott
- Faculty of Health and Human Sciences, Plymouth University, Plymouth, UK
| | | | | | - Sarah Purdy
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | | | - Rod Sheaff
- School of Government, Faculty of Business, Plymouth University, Plymouth, UK
| | - Richard Byng
- Centre for Clinical Trials and Population Studies, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
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Gallagher R, Gallagher P, Roche M, Fry M, Chenoweth L, Stein-Parbury J. Nurses' perspectives of the impact of the older person on nursing resources in the emergency department and their profile: A mixed methods study. Int Emerg Nurs 2015; 23:312-6. [DOI: 10.1016/j.ienj.2015.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 03/18/2015] [Accepted: 03/25/2015] [Indexed: 11/28/2022]
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Yanes AF, McElroy LM, Abecassis ZA, Holl J, Woods D, Ladner DP. Observation for assessment of clinician performance: a narrative review. BMJ Qual Saf 2015; 25:46-55. [PMID: 26424762 DOI: 10.1136/bmjqs-2015-004171] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 09/13/2015] [Indexed: 11/03/2022]
Abstract
BACKGROUND Video recorded and in-person observations are methods of quality assessment and monitoring that have been employed in high risk industries. In the medical field, observations have been used to evaluate the quality and safety of various clinical processes. This review summarises studies utilising video recorded or in-person observations for assessing clinician performance in medicine and surgery. METHODS A search of MEDLINE (PubMed) was conducted using a combination of medical subject headings (MeSH) terms. Articles were included if they described the use of in-person or video recorded observations to assess clinician practices in three categories: (1) teamwork and communication between clinicians; (2) errors and weaknesses in practice; and (3) compliance and adherence to interventions or guidelines. RESULTS The initial search criteria returned 3215 studies, 223 of which were identified for full text review. A total of 69 studies were included in the final set of literature. Observations were most commonly used in data dense and high risk environments, such as the emergency department or operating room. The most common use was for assessing teamwork and communication factors. CONCLUSIONS Observations are useful for the improvement of healthcare delivery through the identification of clinician lapses and weaknesses that affect quality and safety. Limitations of observations include the Hawthorne effect and the necessity of trained observers to capture and analyse the notes or videos. The comprehensive, subtle and sensitive information observations provided can supplement traditional quality assessment methods and inform targeted interventions to improve patient safety and the quality of care.
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Affiliation(s)
- Arianna F Yanes
- Transplant Outcomes Research Collaborative, Northwestern University, Chicago, Illinois, USA
| | - Lisa M McElroy
- Transplant Outcomes Research Collaborative, Northwestern University, Chicago, Illinois, USA Center for Healthcare Studies, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Zachary A Abecassis
- Transplant Outcomes Research Collaborative, Northwestern University, Chicago, Illinois, USA
| | - Jane Holl
- Center for Healthcare Studies, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Donna Woods
- Center for Healthcare Studies, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Daniela P Ladner
- Transplant Outcomes Research Collaborative, Northwestern University, Chicago, Illinois, USA Center for Healthcare Studies, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Santos JLGD, Pestana AL, Higashi GDC, Oliveira RJTD, Cassetari SDSR, Erdmann AL. Organizational context and care management by nurses at emergency care units. Rev Gaucha Enferm 2014; 35:58-64. [DOI: 10.1590/1983-1447.2014.04.45221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
The purpose of this study was to understand the meanings attributed to the organizational context and the role of nurses in care management at emergency care units. This study was based on qualitative research and the Grounded Theory methodological framework. Data were collected from September 2011 to June 2012 by means of semi-structured interviews with 20 participants from two emergency care units (UPA) in southern Brazil, divided into three sample groups. The context is marked by constraints that hinder communication and interaction between professionals and the search of assistance by patients with demands that are not resolved at other levels of care. This scenario highlights the performance of nurses in the managerial dimension of their work, who assume the responsibility for managing care and coordinating professional actions in favour of improved care practices.
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Implications of the emergency department triage environment on triage practice for clients with a mental illness at triage in an Australian context. ACTA ACUST UNITED AC 2014; 17:23-9. [DOI: 10.1016/j.aenj.2013.11.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Revised: 11/22/2013] [Accepted: 11/27/2013] [Indexed: 11/21/2022]
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Montgomery P, Godfrey M, Mossey S, Conlon M, Bailey P. Emergency department boarding times for patients admitted to intensive care unit: Patient and organizational influences. Int Emerg Nurs 2013; 22:105-11. [PMID: 23978577 DOI: 10.1016/j.ienj.2013.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 06/17/2013] [Accepted: 06/26/2013] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Critically ill patients can be subject to prolonged stays in the emergency department following receipt of an order to admit to an intensive care unit. The purpose of this study was to explore patient and organizational influences on the duration of boarding times for intensive care bound patients. METHODS This exploratory descriptive study was situated in a Canadian hospital in northern Ontario. Through a six-month retrospective review of three data sources, information was collected pertaining to 16 patient and organizational variables detailing the emergency department boarding time of adults awaiting transfer to the intensive care unit. Data analysis involved descriptive and non-parametric methods. RESULTS The majority of the 122 critically ill patients boarded in the ED were male, 55 years of age or older, arriving by ground ambulance on a weekday, and had an admitting diagnosis of trauma. The median boarding time was 34 min, with a range of 0-1549 min. Patients designated as most acute, intubated, and undergoing multiple diagnostic procedures had statistically significantly shorter boarding times. DISCUSSION The study results provide a profile that may assist clinicians in understanding the complex and site-specific interplay of variables contributing to boarding of critically ill patients.
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Affiliation(s)
- Phyllis Montgomery
- School of Nursing, Laurentian University, Ramsey Lake Road, Sudbury, Ontario P3E 2C6, Canada.
| | - Michelle Godfrey
- School of Nursing, Laurentian University, Ramsey Lake Road, Sudbury, Ontario P3E 2C6, Canada
| | - Sharolyn Mossey
- School of Nursing, Laurentian University, Ramsey Lake Road, Sudbury, Ontario P3E 2C6, Canada
| | - Michael Conlon
- Epidemiology, Outcomes & Evaluation, Northeast Cancer Centre, Health Sciences North, 41 Ramsey Lake Road, Sudbury, Ontario, Canada
| | - Patricia Bailey
- School of Nursing, Laurentian University, Ramsey Lake Road, Sudbury, Ontario P3E 2C6, Canada
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The emergency department "carousel": an ethnographically-derived model of the dynamics of patient flow. Int Emerg Nurs 2013; 22:3-9. [PMID: 23669027 DOI: 10.1016/j.ienj.2013.01.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Revised: 01/04/2013] [Accepted: 01/10/2013] [Indexed: 11/23/2022]
Abstract
Emergency department (ED) overcrowding reduces efficiency and increases the risk of medical error leading to adverse events. Technical solutions and models have done little to redress this. A full year's worth of ethnographic observations of patient flow were undertaken, which involved making hand-written field-notes of the communication and activities of emergency clinicians (doctors and nurses), in two EDs in Sydney, Australia. Observations were complemented by semi-structured interviews. We applied thematic analysis to account for the verbal communication and activity of emergency clinicians in moving patients through the ED. The theoretical model that emerged from the data analysis is the ED "carousel". Emergency clinicians co-construct a moving carousel which we conceptualise visually, and which accounts for the collective agency of ED staff, identified in the findings. The carousel model uniquely integrates diagnosis, treatment and transfer of individual patients with the intellectual labour of leading and coordinating the department. The latter involves managing staff skill mix and the allocation of patients to particular ED sub-departments. The model extends traditional patient flow representations and underlines the importance of valuing ethnographic methods in health services research, in order to foster organisational learning, and generate creative practical and policy alternatives that may, for example, reduce or ameliorate access block and ED overcrowding.
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Santos JLGD, Lima MADDS, Pestana AL, Garlet ER, Erdmann AL. Desafios para a gerência do cuidado em emergência na perspectiva de enfermeiros. ACTA PAUL ENFERM 2013. [DOI: 10.1590/s0103-21002013000200006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJETIVO: Analisar os desafios para a gerência do cuidado em um serviço hospitalar de emergência, com base na perspectiva de enfermeiros. MÉTODOS: Pesquisa qualitativa, do tipo descritiva e exploratória, realizada de junho a setembro/2009, por meio de entrevista semiestruturada com 20 enfermeiros do Serviço de Emergência de um Hospital Universitário da Região Sul do Brasil. Os dados foram analisados mediante análise temática. RESULTADOS: Os principais desafios dos enfermeiros na gerência do cuidado em emergência foram gerenciamento da superlotação, manutenção da qualidade do cuidado e utilização da liderança como instrumento gerencial. As sugestões citadas para superá-los foram reorganização do sistema de saúde para atenção às urgências, alteração no fluxo de atendimento dos pacientes e realização de capacitação sobre o gerenciamento de enfermagem. CONCLUSÃO: Tais desafios e estratégias representam um impulso para o desenvolvimento de novas práticas por intermédio de um trabalho colaborativo e articulado com a rede de atenção às urgências.
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Paltved C, Musaeus P. Qualitative Research on Emergency Medicine Physicians: A Literature Review. ACTA ACUST UNITED AC 2012. [DOI: 10.4236/ijcm.2012.37a136] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Nugus P, Holdgate A, Fry M, Forero R, McCarthy S, Braithwaite J. Work pressure and patient flow management in the emergency department: findings from an ethnographic study. Acad Emerg Med 2011; 18:1045-52. [PMID: 21996069 DOI: 10.1111/j.1553-2712.2011.01171.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES In this hypothesis-generating study, we observe, identify, and analyze how emergency clinicians seek to manage work pressure to maximize patient flow in an environment characterized by delayed patient admissions (access block) and emergency department (ED) crowding. METHODS An ethnographic approach was used, which involved direct observation of on-the-ground behaviors, when and where they happened. More than 1,600 hours over a 12-month period were spent observing approximately 4,500 interactions across approximately 260 emergency physicians and nurses, emergency clinicians, and clinicians from other hospital departments. The authors content analyzed and thematically analyzed more than 800 pages of field notes to identify indicators of and responses to pressure in the day-to-day ED work environment. RESULTS In response to the inability to control inflow, and the reactions of inpatient departments to whom patients might be transferred, emergency clinicians: reconciled urgency and acuity of conditions; negotiated and determined patients' admission-discharge status early in their trajectories; pursued predetermined but coevolving pathways in response to micro- and macroflow problems; and exercised flexibility to reduce work pressure by managing scarce time and space in the ED. CONCLUSIONS To redress the linearity of most literature on patient flow, this study adopts a systems perspective and ethnographic methods to bring to light the dynamic role that individuals play, interacting with their work contexts, to maintain patient flow. The study provides an empirical foundation, uniquely discernible through qualitative research, about aspects of ED work that previously have been the subject only of discussion or commentary articles. This study provides empirical documentation of the moment-to-moment responses of emergency clinicians to work pressure brought about by factors outside much of their control, establishing the relationship between patient flow and work pressure. We conceptualize the ED as a dynamic system, combining socioprofessional influences to reduce and control work pressure in the ED. Interventions in education, practice, policy, and organizational performance evaluations will be supported by this systematic documentation of the complexity of emergency clinical work. Future research involves testing the five findings using systems dynamic modeling techniques.
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Affiliation(s)
- Peter Nugus
- Centre for Clinical Governance Research in Health, Australian Institute of Health Innovation, Faculty of Medicine, University of New South Wales, Sydney, Australia.
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Nugus P, Carroll K, Hewett DG, Short A, Forero R, Braithwaite J. Integrated care in the emergency department: A complex adaptive systems perspective. Soc Sci Med 2010; 71:1997-2004. [DOI: 10.1016/j.socscimed.2010.08.013] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2009] [Revised: 08/05/2010] [Accepted: 08/24/2010] [Indexed: 10/19/2022]
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